Hospital Surgical Volumes and Mortality after Coronary Artery Bypass Grafting: Using International Comparisons to Determine a Safe Threshold. (16th May 2016)

• Record Type: Journal Article
• Authors: Gutacker, Nils; Bloor, Karen; Cookson, Richard; Gale, Chris P.; Maynard, Alan; Pagano, Domenico; Pomar, José; Bernal‐Delgado, Enrique
• Is Part Of: Health services research. Volume 52:Number 2(2017)
• Page Start: 863
• Page End: 878
• Publication Date: 2016-05-16
• Subjects: Coronary artery bypass surgery -- center‐volume -- mortality -- international comparisons; Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.12508
• Languages: English
• ISSNs: 0017-9124

Abstract

Abstract : Objective: To estimate a safe minimum hospital volume for hospitals performing coronary artery bypass graft (CABG) surgery. Data Source: Hospital data on all publicly funded CABG in five European countries, 2007–2009 (106, 149 patients). Design: Hierarchical logistic regression models to estimate the relationship between hospital volume and mortality, allowing for case mix. Segmented regression analysis to estimate a threshold. Findings: The 30‐day in‐hospital mortality rate was 3.0 percent overall, 5.2 percent (95 percent CI: 4.0–6.4) in low‐volume hospitals, and 2.1 percent (95 percent CI: 1.8–2.3) in high‐volume hospitals. There is a significant curvilinear relationship between volume and mortality, flatter above 415 cases per hospital per year. Conclusions: There is a clear relationship between hospital CABG volume and mortality in Europe, implying a "safe" threshold volume of 415 cases per year.